Medical

Medical management of anorectal conditions:

Haemorrhoids

A meta-analysis supports use of early fibre supplements to improve symptoms and to prevent straining [3]. Good anal hygiene is also important.

There is widespread use of topical local anaesthetic and steroid creams although little evidence to support their use and they may be harmful in the long term [3].

Anal fissure

The pain is normally due to spasm of the internal sphincter rather than the actual fissure [5], so anything that reduces spasm should promote healing. Glyceral trinitrate (GTN) ointment is generally used as a first-line treatment with good success, although recent trials have shown healing rates no better than placebo injections.

Calcium-channel blockers may be a promising future treatment with fewer side effects (such as headache) than GTN [5,9].

Anorectal abscesses

Anorectal abscesses always require surgical intervention.

Adjunctive antibiotics are normally only needed if the abscess is complicated, deep, associated with cellulitis or the patient is immunocompromised [1].

Pilonidal disease

A pilonidal sinus, without abscess formation, can benefit from good hygiene and the shaving of hairs in the natal cleft, both of which promote healing [4].

Learning-bite

There is little firm evidence to support medical therapies in anorectal conditions except fibre supplements in the management of haemorrhoids.